Please Print this form and Mail or fax to:

Marine Unlimited 3335 Standish Ave Santa Rosa, CA  95407
Phone No. 707-585-9717
Fax No.  707-584-7053

Please print with black ink

Applicant ____________________________ Social Security Number_____________ Date of Birth__________ DL#__________

Home Address_____________________________City________________________State_______Zip Code_________

How long have you lived at the above address Years_______ Months_______ Home Phone # ____________________

Do you Rent or Own?___________________ Monthly Payment _______________________

Have you ever filed Bankruptcy? _______________________ if yes, when ___________________________________

Mailing Address____________________________City________________________State_______Zip Code_________

Co Applicant _____________________ Social Security Number_________________ Date of Birth__________ DL#___________

Home Address_____________________________City________________________State_______Zip Code_________

How long have you lived at the above address Years_______ Months_______ Home Phone # ____________________

Do you Rent or Own?___________________ Monthly Payment _______________________

Have you ever filed Bankruptcy? _______________________ if yes, when ___________________________________

Mailing Address____________________________City________________________State_______Zip Code_________

Applicant Employer Information-------------------------------------------------------------------------------------------------------------------------------------

Present Employer (type of business if self-employed)___________________________________________________

Employer's Address ________________________City________________________State_______Zip Code_________

Your Position_____________________________________ How Long at this job Years________ Months__________

Employers Phone number __________________________Gross Monthly Income _______________

Co-Applicant Employer Information ------------ -----------------------------------------------------------------------------------------------------------------

Present Employer (type of business if self-employed)___________________________________________________

Employer's Address ________________________City________________________State_______Zip Code_________

Your Position__________________________________ How Long at this job Years________ Months__________

Employers Phone number __________________________Gross Monthly Income _______________

Total household monthly income $___________________

I/WE GIVE THE ABOVE INFORMATION FOR THE PURPOSE OF OBTAINING CREDIT AND AUTHORIZE MARINE UNLIMITD (DEALER) TO OBTAIN INFORMATION CONCERNING ANY STATEMENTS MADE HEREIN. I AUTHORIZE THE BANK TO CONTACT ME AT ANY TELEPHONE NUMBERS PROVIDED, LISTED IN MY NAME OR IN THAT OF ANY FAMILY MEMBER OR PROVIDED TO THE BANK BY ANY OTHER PERSON.

X____________________________________________ Date____________ Purchaser's Signature

X____________________________________________ Date____________ Purchaser's Signature

This form is in printable form only to provide you with the highest level of security Please mail to Marine Unlimited at the address listed above. If you choose to E-Mail this form we can not be responsible for security while in transit over unsecure Internet lines.